冻融胚胎移植妊娠相关因素的回顾性分析

发布时间：2018-05-24 16:04

本文选题：冻融胚胎 + 妊娠结局　；参考：《河北医科大学》2014年硕士论文

【摘要】：目的：对进行冻融胚胎移植(Frozen-thawed embryo transfer,FET)患者的各因素进行统计分析，探讨影响胚胎着床率、临床妊娠率以及流产率的相关因素。方法：将2012年1月1日至2013年8月31日在河北医科大学第四医院生殖医学中心进行冻融胚胎移植的498个移植周期资料作为研究对象，回顾性分析患者年龄、体重指数、内膜准备方案、移植日内膜厚度、血雌二醇水平、移植胚胎个数、受精方式对胚胎着床率、临床妊娠率及流产率的影响。结果：总体结果：498例冻融胚胎移植周期，共移植胚胎1177个，平均每周期移植胚胎2.36±0.59个。其中着床胚胎共348个，胚胎种植率为29.57%。临床妊娠245周期，未妊娠253周期，临床妊娠率为49.20%，其中异位妊娠8例，异位妊娠率为3.27%，多胎妊娠4例，多胎妊娠率为1.63%，流产26例，流产率为10.61%。 1内膜准备方案：共分为四组，即自然周期组、促排卵周期组、激素替代周期组、垂体降调节激素替代周期组。自然周期组着床率明显低于其余三组，差异有统计学意义，P0.05。自然周期组临床妊娠率明显低于其余三组，与促排卵周期组及降调节激素替代周期组比较差异有统计学意义，P0.05,与激素替代周期组比较差异无统计学意义，P0.05。四组间流产率比较差异无统计学意义，P0.05。 2内膜厚度：内膜厚度7mm-23mm，平均厚度为11.10±2.63mm。共分为四组，即8mm组、8-11.9mm组、12-15.9mm组及≥16mm组。四组间胚胎着床率、临床妊娠率间差异未见统计学差异，P0.05。四组间流产率比较有统计学意义，P0.05。 3雌二醇：雌二醇范围为15.88pg/ml-2338.0pg/ml。自然周期及促排卵周期，雌二醇分为110pg/ml、110-330pg/ml、330pg/ml三组。三组间着床率、临床妊娠率、流产率差异均无统计学意义，P0.05。激素替代周期组及垂体降调节激素替代周期组，雌二醇分为260pg/ml、260-1330pg/ml、1330pg/ml三组。三组间着床率、临床妊娠率差异无统计学意义，P0.05，三组间流产率差异具有统计学意义，P0.05。 4年龄：年龄范围20岁-47岁，平均年龄为30.39±4.58岁。分为30岁，30岁-35岁，35岁三组。35岁组胚胎着床率、临床妊娠率均低于其余两组，差异有统计学意义，P0.05。35岁组流产率明显高于其余两组，与30岁组比较差异有统计学意义，P0.05，与30岁-35岁组比较差异无统计学意义，P0.05。 5体重指数：体重指数范围为15.63-38.57kg/m2，平均体重指数为23.27±3.51kg/m2。分为18.5kg/m2、18.5-24kg/m2、24-27kg/m2、≥27kg/m2四组。四组间胚胎着床率、临床妊娠率、流产率差异均无统计学意义，P0.05。 6移植胚胎个数：分为移植一个、两个、三个胚胎共三组。三组间胚胎着床率差异无统计学意义，P0.05。三组间临床妊娠率差异无统计学意义，P0.05，移植三个胚胎组临床妊娠率最高，为53.33%。移植一个胚胎组共妊娠10例，无流产发生，另两组间流产率差异无统计学意义，P0.05。 7受精方式：分为体外受精(In vitro fertilization and embryo transfer,IVF)组及卵胞浆内单精子注射(Intracytoplasmic single sperm injection,ICSI)组，IVF组与ICSI组着床率、妊娠率及流产率差异均不明显，无统计学意义，P0.05。 8影响冻融胚胎移植临床妊娠率的多因素logistic回归分析显示：内膜厚度、移植胚胎个数、年龄与临床妊娠显著相关，内膜准备方案、体重指数、受精方式与临床妊娠无显著相关。结论： 1在临床处理、冻融水平稳定的情况下，，年龄、子宫内膜厚度、移植胚胎个数是影响FET妊娠结局的重要因素。 2体重指数、受精方式对妊娠结局无明显影响。 3降调节激素替代方案能获得较高的妊娠率，可能是一种较好的准备方式，但仍需更多研究证实。 4ICSI与IVF相比冻融复苏率、妊娠结局无显著性差异，是治疗男性不育的重要方法之一，但应注意ICSI助孕的潜在风险，谨慎应用。
[Abstract]:Objective: to analyze the factors of Frozen-thawed embryo transfer (FET) and to discuss the factors that affect the implantation rate, the clinical pregnancy rate and the abortion rate.
Methods: from January 1, 2012 to August 31, 2013, the data of 498 transplantation cycles of frozen thawing embryo transfer were carried out at the reproductive medical center of Fourth Hospital of Hebei Medical University. The age, body mass index, intimal preparation, the thickness of the endometrium, the level of estradiol, the number of transplanted embryos and the fertilization mode were analyzed. The influence of embryo implantation rate, clinical pregnancy rate and abortion rate on embryo implantation rate was analyzed.
Results: total results: 498 cases of frozen thawing embryo transfer period, 1177 embryos were transplanted, with an average of 2.36 + 0.59 embryos per cycle, including 348 implantation embryos, the embryo implantation rate was 29.57%. clinical pregnancy 245 cycles, no pregnancy 253 cycles, the clinical pregnancy rate was 49.20%, ectopic pregnancy was 8, the ectopic pregnancy rate was 3.27%, multiple pregnancy 4. The rate of multiple pregnancy was 1.63%, 26 cases were aborted, and the abortion rate was 10.61%.
1 endometrium preparation program: a total of four groups, namely, natural cycle group, ovulation cycle group, hormone replacement cycle group, pituitary descending regulation hormone replacement cycle group. The implantation rate of natural cycle group is significantly lower than the other three groups, the difference is statistically significant, the clinical pregnancy rate of P0.05. natural cycle group is significantly lower than the other three groups, and the group and descending group of ovulation stimulating cycle and descending. The difference of the hormone replacement cycle group was statistically significant, P0.05, compared with the hormone replacement cycle group, there was no statistical difference, and there was no significant difference in the abortion rate between the four groups of P0.05., P0.05.
2 intimal thickness: the thickness of the endometrium 7mm-23mm and the average thickness of 11.10 + 2.63mm. were divided into four groups, that is, group 8mm, group 8-11.9mm, 12-15.9mm and 16mm. There was no statistical difference between the four groups of embryo implantation rate and clinical pregnancy rate. The abortion rate between the four groups of P0.05. four groups was statistically significant, P0.05.
3 estradiol: the estradiol range is 15.88pg/ml-2338.0pg/ml. natural cycle and ovulation cycle. Estradiol is divided into 110pg/ml, 110-330pg/ml, 330pg/ml three groups. There is no significant difference between the three groups of implantation rates, clinical pregnancy rate, and abortion rate, P0.05.
Hormone replacement cycle group and pituitary descending regulation hormone replacement cycle group, estradiol was divided into 260pg/ml, 260-1330pg/ml, 1330pg/ml three groups. There was no statistically significant difference in the rate of implantation between the three groups and the clinical pregnancy rate, P0.05, the difference of abortion rate between the three groups was statistically significant, P0.05.
4 age: age range of 20 years old -47 years, the average age is 30.39 + 4.58 years old. It is divided into 30 years old, 30 year old -35 years old, 35 year old and three group.35 age group embryo implantation rate. The clinical pregnancy rate is lower than the other two groups, the difference is statistically significant higher than the other two groups, compared with the 30 year group, the difference is statistically significant, P0.05, and 30 year -35 years old group. The difference was not statistically significant, P0.05.
5 body mass index: the body mass index range was 15.63-38.57kg/m2, the average body mass index was 23.27 + 3.51kg/m2., 18.5kg/m2,18.5-24kg/m2,24-27kg/m2 and four groups. Four groups of embryo implantation rate, clinical pregnancy rate and abortion rate were not statistically significant, P0.05.
6 the number of transplanted embryos, divided into one, two and three embryos, three groups. There was no significant difference in the implantation rate between the three groups. There was no significant difference in the clinical pregnancy rate between the groups of P0.05. three, P0.05, the highest clinical pregnancy rate of the three embryo transfer groups was in the group of 53.33%. transplantation, and there were 10 cases of pregnancy without abortion, and two groups between the other two groups. There was no significant difference in the rate of abortion, P0.05.
7 methods of fertilization were divided into group In vitro fertilization and embryo transfer, IVF, and intracytoplasmic sperm injection (Intracytoplasmic single sperm injection, ICSI).
8 the multiple factor Logistic regression analysis of the clinical pregnancy rate of frozen thawing embryo transfer showed that the thickness of the endometrium, the number of transplanted embryos, age were significantly related to the clinical pregnancy, and the intimal preparation, body mass index, and fertilization were not significantly related to the clinical pregnancy.
Conclusion:
1 age, endometrial thickness and number of embryos transferred are important factors affecting the pregnancy outcome of FET.
2 body mass index and fertilization did not significantly affect pregnancy outcome.
3 the hormone replacement therapy can achieve higher pregnancy rate. It may be a better preparation method, but more studies need to be done.
There is no significant difference in the pregnancy outcome between 4ICSI and IVF. There is no significant difference in pregnancy outcome. It is one of the important methods for the treatment of male infertility. However, the potential risk of ICSI assisted pregnancy should be paid attention to, and it should be carefully applied.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

【引证文献】